2023 Mason Scholarship Application Form

2023 Mason County Farm Bureau Scholarship Application Form
Please read all instructions carefully. Filling out an incomplete application or not following all instructions may or may not result in your application being discarded.
Name*

First NameLast Name
Student's Email*
example@example.com
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last 4 digits of Social Security Number:*
Parent or Guardian's Name*

First NameLast Name
Parent or Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian's Phone Number*

Area CodePhone Number
Is your parent or guardian a Mason County Farm Bureau Member?*

YesNo

Educational Information
Name of High School Attended*

HavanaMidwest CentralIllini CentralA-C CentralHome schooled
Year of Graduation*
Ranking in Graduation Class*
High School GPA*
List scale (Ex: 3.9/4.0)
High School Counselor*
ACT Score
Skip question if not applicable
SAT Score
Skip question if not applicable
Academic awards and/or honors you received in High School (Provide a list)*
Are you a member of any organization in your school? (Provide list of name of organization, length of membership, and any offices held)*
List any agricultural classes taken that will benefit you in any future ag opportunities (Provide list):*
List any community, sport, or other activities you participated in (Provide list)*
List any work experience. Include where, when, who your supervisor(s) were, and what your job entails (Provide list)*

Essay
What are your goals for the next 5 years (complete sentences)?*
What are your goals for the next 20 years (complete sentences)?*
Essays must be original and created by the applicant. They must be typewritten, more than 250 words but less than 500 words,and double-spaced. The theme for 2023 is “What does the future of agriculture look like to you, and what skills will you need to play a part in it?” Content, adherence to the theme, grammar, spelling, and punctuation will be judged. Fifty percent of the overall score is based on the essay. Please attach this form here:*

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I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE REMOVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.

I have completed the application to the best of my ability. The attached essay is my original work. I understand the $1,000 scholarship will be sent to the financial aid office of the college at which I enroll. You may use my name and pictures for promotion of the scholarship if I am selected as a recipient.

Please return this completed form with an essay attached by 4:00 pm, March 31st, 2023.
Signature*

Clear
Date Signed by Applicant*

MonthDayYear
Date
Should be Empty:

2023 Mason County Farm Bureau Scholarship Application Form